Health Care Fraud Story Archives - West Virginia Public Broadcasting

New Initiative Will Combat Healthcare Fraud In W.Va.

Officials have launched a new initiative to combat health care fraud in West Virginia, U.S. Attorney William Ihlenfeld said.

State and federal agencies gathered at the U.S. Attorney’s Office in Wheeling on Tuesday for the first meeting of the Mountaineer Health Care Fraud Strike Force, news outlets reported citing a statement from Ihlenfeld. The unit will use data to uncover waste and abuse.

Representatives from seven agencies discussed fraudulent billing patterns and identified new targets, Ihlenfeld said. The strike force also will engage with providers and insurers to gain a better understanding on recognizing and reporting health care fraud, he said.

“The time I spent in the private sector opened my eyes to the scope of the health care fraud that is occurring in West Virginia,” Ihlenfeld said. “It made me realize that more can and should be done by law enforcement, which is why this new group has been formed.”

Northern W.Va. Group Formed to ID Health Care Fraud

State and federal authorities have created a multi-jurisdictional working group to identify and deal with health care fraud in northern West Virginia.

U.S. Attorney William J. Ihlenfeld II and representatives of the FBI, the IRS and the state Medicaid Fraud Control Unit announced the group’s formation on Thursday. Assistant U.S. Attorney Sarah Montoro is the group’s leader.

Ihlenfeld says investigators are using advanced statistical analysis of medical providers’ health care reimbursement data to identify potentially fraudulent billing patterns, waste and abuse.

Also Thursday, Ihlenfeld announced a settlement of claims involving a Fairmont physician. Dr. Samer Kuzbari paid $440,232 to resolve allegations that he submitted false claims to Medicare, Medicaid and other health care benefit programs.

Pharmacy Owner Sentenced in Fraud Case

A Charleston pharmacy will spend three years on probation for defrauding Medicare and Medicaid.

U.S. Attorney Booth Goodwin says Trivillian’s Pharmacy and its former owner, Paula J. Butterfield, were sentenced on Tuesday in U.S. District Court in Charleston. Butterfield will spend a year and a day in prison.

Butterfield pleaded guilty in February to making a false statement in a health care matter. She also pleaded guilty on behalf of the pharmacy to health care fraud and misbranding drugs.

Goodwin says the pharmacy admitted to dispensing compounded drugs and generic drugs and billing Medicare and Medicaid for brand name drugs, which are more expensive. Butterfield admitted to submitting false claims to Medicare on her own behalf.

Trivillian’s will forfeit more than $355,000 from the scheme to the government.

Charleston Pharmacy Owner Pleads Guilty in Fraud Case

A Charleston pharmacy owner faces up to five years in prison after pleading guilty to making a false statement in a health care matter.

Paula Butterfield also pleaded guilty on behalf of her business, Trivillian’s Pharmacy, to health care fraud and misbranding drugs.

U.S. Attorney Booth Goodwin says the pharmacy faces a fine, up to 10 years of probation and restitution.

Butterfield entered the pleas Wednesday in U.S. District Court in Charleston. She and the pharmacy are scheduled to be sentenced May 28.

Goodwin says Butterfield admitted that the pharmacy dispensed compounded drugs and generic drugs and billed Medicare and Medicaid for brand name drugs, which are more expensive. Butterfield submitted false claims to Medicare on her own behalf.